Interleukin-7 and interleukin-15 as prognostic biomarkers in sepsis and septic shock: Correlation with inflammatory markers and mortality.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection and a syndrome shaped by pathogen and host factors evolving over time. During sepsis, the absolute number of lymphocytes decreases. CD4+ and CD8+ T cells, B cells, and NK cells are reduced. Lymphocytes are an essential element of the body's defence against pathogens. Interleukin 7 has strong anti-apoptotic properties and induces the proliferation of CD4+ and CD8+ T lymphocytes. IL-15 prompts the generation of mature NK cells in the bone marrow, plays an important role in the generation, cytotoxicity, and survival of CD8+ T lymphocytes, and is essential for the survival of natural killer T (NKT) and intestinal intraepithelial lymphocytes (IELs). The study highlights the importance of monitoring IL-7 levels in patients with sepsis and septic shock, as low levels of this cytokine were associated with an increased risk of mortality. Physicians should consider using IL-7 levels as a biomarker to identify patients who are at higher risk of mortality and may require more aggressive treatment.

THE FRAMEWORK OF THE PILOT PROJECT FOR TESTING A TELEMEDICINE MODEL IN THE FIELD OF GERIATRICS - HEALTH CHALLENGES AND JUSTIFICATION OF THE PROJECT IMPLEMENTATION.

OBJECTIVE: Aim: To present the essentials of the pilot project for testing a telemedicine model in the field of geriatrics, along with a snapshot of the health challenges. PATIENTS AND METHODS: Materials and Methods: This review paper use the synthetic method summarizing the main objectives of the telemedicine project in the field of geriatrics. The described project involving telemedical care of patients with geriatric complexes in the area of frailty syndrome, sarcopenia and malnutrition, according to the proposed model addresses the aforementioned problems. The project provides a holistic model of home and outpatient care, which will allow concerting on 3 groups of the above-mentioned geriatric syndromes. The project will have a pilot character and is aimed at clinical verification through the introduction (implementation) of the new method and accompanying organizational and technological solutions (platform, equipment) in an area where current models and schemes of therapeutic and diagnostic support were insufficient. CONCLUSION: Conclusions: The implementation of telemedicine solutions creates an opportunity for geriatric patients and their families by improving access to specialized medical care. This project will support patients, but also caregivers, who (through training and telemedicine) will be better able to provide care services with the ability to reconcile them with their own work.

THE FRAMEWORK OF THE PILOT PROJECT FOR TESTING A TELEMEDICINE MODEL IN THE FIELD OF CHRONIC DISEASES - HEALTH CHALLENGES AND JUSTIFICATION OF THE PROJECT IMPLEMENTATION.

OBJECTIVE: Aim: To present the essentials of the pilot project for testing a telemedicine model in the field of chronic diseases, along with a snapshot of the health challenges. PATIENTS AND METHODS: Materials and Methods: This review paper use the synthetic method summarizing the main objectives of the telemedicine project in the field of chronic diseases with a focus on COPD. The described project will have a pilot character and is aimed at clinical verification through the implementation of a new method and accompanying organizational and technological solutions (platform, devices) in an area where current models and schemes of therapeutic and diagnostic support were insufficient. The main (primary) outcome will be the leveling of social inequalities in health by reducing the residence and income factor in access to screening and medical services through the use of telemedicine. CONCLUSION: Conclusions: Implementation of telemedicine solutions creates an opportunity for patients diagnosed with COPD and their families by improving access to specialized medical care. With early detection of COPD exacerbation symptoms (deterioration of remotely monitored spirometric parameters), it will be possible to introduce appropriate preventive measures for these patients offsetting the adverse consequences.

Acceptance of illness, quality of life and nutritional status of patients after lower limb amputation due to diabetes mellitus.

INTRODUCTION: Diabetes mellitus is one of the most common chronic diseases with a high number of sufferers worldwide. Diabetic neuropathy and diabetic angiopathy lead to serious infectious complications which are very difficult to combat and may finally lead to the amputation of a lower limb. The aim of the study was to evaluate the quality of life, the level of acceptance of the illness and the nutritional status of patients after lower limb amputation due to diabetes. METHODS: Ninety-nine patients (23 men and 76 women) were enrolled into the study. They had all undergone lower limb amputation due to diabetic foot and were treated in the Department of General and Oncological Surgery. The following questionnaires were used: the WHO Quality of Life-BREF (WHOQOL-BREF), the Mini Nutritional Assessment (MNA), the Acceptance of Illness Scale (AIS) and the anonymous specific socio-demographic characteristics questionnaire. RESULTS: The diabetes-related amputees were revealed to have a higher QoL within the social domain (mean score 64.48), an intermediate QoL - within the environmental domain (mean score 63.04) and the mental domain (mean score 59.61), and a lower QoL - within physical (somatic) domain (mean score 54.69). There was no statistical correlation between genders or between all the domains of QoL (P > 0.05). The mean MNA score was 22.66, which means that patients were at risk of malnutrition. There were statistical differences between women and men as regards nutritional status (P = 0.034). The mean AIS score was 27.65 (27.09 women and 29.48 men), which means that the respondents accept their disease. There was no statistical correlation between gender and the acceptance of the disease (P = 0.288). There was not statistical correlation between age and QoL (P > 0.05). There were statistical differences between age and nutritional status (P < 0.05), and between age and acceptance of the illness (P = 0.044). CONCLUSIONS: The better the quality of life was in all the domains, the better the level of acceptance of illness was. The less malnourished the patient was, the better their quality of life was in all the domains.

Benefit of Biological Drugs for Quality of Life in Patients with Ankylosing Spondylitis: A Systematic Review and Meta-Analysis of Clinical Trials.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease involving the axial skeleton, peripheral joints, and extra-articular manifestations like psoriasis, inflammatory bowel disease, or uveitis. A deterioration of quality of life (QoL) affects the disease management and therapeutic decision-making. This meta-analysis focused on the influence of biological drugs on the QoL in SA compared to the effects of other therapeutic modalities. We searched the databases of MedLine, Academic Search Ultimate, CINAHL Complete, and Health Source - Nursing/Academic Edition for articles related to AS treatment using the terms "ankylosing spondylitis" OR "rheumatoid spondylitis" OR "spondylitis" AND "quality of life" OR "patient-reported outcomes" OR "well-being" OR "health-related quality of life" OR "biological treatment". The search came up with 10 English-language articles published between 2010 and 2020. Patients were evaluated with the following indexes and questionnaires: Assessment of Spondyloarthritis International Society (ASAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Quality of Life (ASQoL), 36-Item Short-Form Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and the Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Functional (BASFI) Indexes. We found that the QoL, assessed with the ASQoL, improved significantly better in patients treated with biological drugs when compared to those treated with other standard therapies or placebo at a 4-month follow-up. However, improvements in other disease characteristics could not be differentiated based on the therapy modality. The finding that biological drugs are superior in improving the QoL should strengthen the recommendations for their use in patients with AS.

Thoracic Manifestation of Granulomatosis with Polyangiitis: A Case Report.

Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibody (ANCA)-associated disorder with necrotic vasculitis of small- and medium-size arteries and veins. In the literature, there are many case reports of patients with GPA of different, sometimes unusual, clinical manifestations. In this paper, we present difficulties that accompanied the process of diagnosing GPA in a 54-year-old symptomatic patient who was. Computer tomography scans showed numerous tumor-like lesions of various and irregular sizes in both lungs. Positron emission tomography scans suggested a lymphoproliferative disease, otherwise failing to provide a clue concerning its nature or localization. After a series of diagnostic twists and turns, inclusive of bronchoalveolar lavage, cervical mediastinoscopy, paratracheal lymph biopsy, and histopathologic examinations, and other tests, the diagnosis of GPA was established as the most probable. The patient was acutely treated with loading doses of methylprednisolone and cyclophosphamide, gradually tapered off during the long-term follow-up. He was discharged from the hospital in a good condition. We conclude that GPA is an uncommon disease with indistinctive signs, which raises the risk of its being overlooked. A diagnostic algorithm is required for patients with suspected GPA. A timely diagnosis is essential as the disease may quickly progress into renal or multiorgan dysfunction, and ultimately lead to death if untreated. Pulmonary involvement may also suggest neoplastic changes.

Impact of satisfaction with physician-patient communication on self-care and adherence in patients with hypertension: cross-sectional study.

BACKGROUND: Hypertension (HT) requires patients to continuously monitor their blood pressure, strictly adhere to therapeutic recommendations, and self-manage their illness. A few studies indicate that physician-patient communication and the patient's satisfaction with the therapeutic relationship may affect the course and outcomes of the treatment process. Research is still lacking on the association between satisfaction with physician-patient communication and adherence to treatment or self-care in chronically ill patients. The aim of the study was to evaluate the relationship between satisfaction with physician-patient communication and self-care and adherence in patients with HT undergoing chronic treatment. METHODS: The following instruments were used: the Adherence to Refills and Medication Scale (ARMS) for evaluating adherence (12-48 points), the Self-Care of Hypertension Inventory (SCHI) for self-care level (0-100 points), and the Communication Assessment Tool (CAT) for evaluating satisfaction with physician-patient communication. Socio-demographic and clinical data were obtained from patients' medical records. The research has a cross-sectional and observational study design. Inclusion criteria were as follows: age > 18 years, hypertension diagnosed per European Society of Hypertension (ESH) guidelines, treatment with at least one antihypertensive drug for the past 6 months, and informed consent. Cognitively impaired patients unable to complete the surveys without assistance were excluded (MMSE ≤18). Correlations between quantitative variables were analyzed using Pearson's or Spearman's correlation coefficient. Linear regression was performed. Variable distribution normality was verified using the Shapiro-Wilk test. RESULTS: The study included 250 patients (110 male, mean age 61.23 ± 14.34) with HT, treated at a hypertension clinic. In the CAT questionnaire individual questions pertaining to satisfaction with physician communication (on the CAT) were rated "excellent" 28.4-50.4% of the time. The best-rated aspects of communication included: letting the patient talk without interruptions (50.4% "excellent" ratings), speaking in a way the patient can understand (47.6%), and paying attention to the patient (47.2%). According to patient reports, physicians most commonly omitted such aspects as encouraging the patient to ask questions (28.4%), involving them in decisions (29.2%), and discussing the next steps (35.2%). The respondents had a low level of adherence to pharmaceutical treatment (16.63 ± 4.6). In terms of self-care, they scored highest in self-care management (64.17 ± 21.18), and lowest in self-care maintenance (56.73 ± 18.57). In correlation analysis, satisfaction with physician-patient communication (total CAT score) was positively correlated with all SCHI domains (self-care maintenance ß = 0.276, self-care management ß = 0.208, self-care confidence ß = 0.286, p < 0.05), and negatively correlated with ARMS scores (indicating better adherence). CONCLUSIONS: Satisfaction with physician-patient communication has a significant impact on self-care and pharmaceutical adherence in patients with hypertension. The more satisfied the patient is with communication, the better their adherence and self-care. TRIAL REGISTRATION: SIMPLE: RID.Z501.19.016.

Chitinase 3-Like 1, Nestin, and Testin Proteins as Novel Biomarkers of Potential Clinical Use in Colorectal Cancer: A Review.

Colorectal cancer is the third most commonly diagnosed cancer in males and the second most common in females. Only 10-20% of patients are diagnosed at the early stage of disease. Recently, the role of novel biomarkers of the neoplastic process in the early detection of colorectal cancer has been widely discussed. In this review, we focused on the three novel biomarkers that are of potential clinical importance in diagnosing and monitoring colorectal cancer. Chitinase 3-like 1 protein, also known as YKL-40, and nestin and testin proteins are produced by colorectal cancer cells. YKL-40 protein is a marker of proliferation, differentiation, and tissue morphogenetic changes. The level of YKL-40 is elevated in about 20% of patients with colorectal cancer. An increased expression of nestin indicates immaturity. It is a marker of angiogenesis in neoplastic processes. Testin protein is a component of cell-cell connections and focal adhesions. The protein is produced in normal human tissues, but not in tumor tissues. Downregulation of testin increases cell motility, spread, and proliferation, and decreases apoptosis. The usefulness and role of these biomarkers, both alone and combined, in the diagnostics of colorectal cancer should be further explored as early cancer detection may substantially improve treatment outcome and patient survival.

Frequency of the use of biological treatment of patients with rheumatoid arthritis and ankylosing spondylitis in Lower Silesia.

BACKGROUND: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic connective tissue diseases. Inadequate treatment of RA and AS results in health failure, disability and premature death. In recent years, development of immunology and genetic engineering techniques has started a new generation of drugs in the treatment of RA and AS, called biologic response modifiers or biologics. It is a very effective therapy of serious RA and AS. In many cases, they represent the only way to improve the quality of life, slowing or even arresting the development of these diseases. According to national statistics, the percentage of patients with rheumatic diseases treated with biologic treatment in Poland is less than 1.5%, and it is much lower than in Western European countries (20%). PURPOSE: The aim of the study was to evaluate the use of biological treatment in Lower Silesia in patients with RA and AS in the years 2006-2015, based on data obtained from the Lower Silesian Branch of the Polish National Health Fund. RESULTS AND CONCLUSIONS: In the last 10 years the frequency of biological treatment of RA or AS in Lower Silesia was estimated as 2.06% of patients (in 2011) to 6.03% of patients (during the first 8 months of 2015). Biological treatment is more often used in Lower Silesia in comparison to national statistics and ranks at a similar level as in other countries of Central and Eastern Europe.

Sleep Disturbances as a Consequence of Long COVID-19: Insights from Actigraphy and Clinimetric Examinations-An Uncontrolled Prospective Observational Pilot Study.

The COVID-19 pandemic represents a global health and social challenge. However, the impact of a SARS-CoV-2 infection itself on mental health and sleep quality remains poorly understood. The purpose of the present uncontrolled prospective observational pilot study was to evaluate the impact of past COVID-19 disease on the incidence of quantitative and qualitative sleep disturbances. A group of 61 subjects (37 female, 24 male) reported sleep disturbances that had lasted for at least one month and had started after recovery from COVID-19. The study used self-reported instruments: the Epworth Sleepiness Scale (ESS) and Insomnia Severity Index (ISI), as well as an objective method-actigraphy-for quantitative analysis of sleep architecture. It was shown that sleep disturbances most commonly started after recovery (68.3%, n = 41) and lasted for more than one month (83.6%, n = 51). ESS scores of 7.8 ± 5.0 points indicate moderate daytime sleepiness, and ISI scores of 16.3 ± 5.8 points denote moderate insomnia. ESS scores were negatively correlated with total time in bed (r = -0.3780, p = 0.003), total sleep time (r = -0.2969, p = 0.020), and wakefulness after sleep onset (r = -0.2654, p = 0.039). In addition, ESS scores were correlated negatively with the respondents' age (B = -0.17, p = 0.000) and time from COVID-19 onset. A positive correlation was found between wakefulness after sleep onset and ESS scores (B = -0.05, p = 0.039). ISI scores were positively correlated with time in bed (r = 0.3275, p = 0.010). Female gender was found to be a significant predictor of insomnia's severity (B = 2.159, t = 3.04, p = 0.004). In conclusion, patients with a history of COVID-19 report long-lasting sleep disturbances that do not subside spontaneously. In the patient group studied, moderate levels of daytime sleepiness and insomnia were found. The most frequently reported problems included irregular sleep, frequent awakenings, and difficulty maintaining sleep, while normal sleep duration was preserved. These findings underscore the need for continued attention to the long-term consequences of COVID-19 on sleep health and emphasize the importance of targeted interventions to address these enduring sleep disturbances in affected individuals.

Reply to Mathieu et al. Omega 3 Fatty Acids Intake Does Not Decrease the Risk of Rheumatoid Arthritis Occurrence: A Meta-Analysis. Comment on "Tanski et al. The Relationship between Fatty Acids and the Development, Course and Treatment of Rheumatoid Arthritis. Nutrients 2022, 14, 1030".

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Psychosocial and behavioral correlates of self-efficacy in treatment adherence in older patients with comorbid hypertension and type 2 diabetes.

BACKGROUND: Adhering to clinical prescriptions is known to protect against the effects of uncontrolled hypertension and of acute and chronic cardiovascular diseases, including diabetes. Contextually, positive associations between self-care behaviors and psychological constructs, such as self-efficacy, are widely acknowledged in the literature. However, still little is known about the psychological factors underlying the patient's self-efficacy. This study aimed to investigate the psychosocial and behavioral correlates of self-efficacy related to treatment adherence in older patients with comorbid hypertension and type 2 diabetes mellitus. PARTICIPANTS AND PROCEDURE: Italian and Polish patients (≥ 65 years; N = 180) consecutively responded to self-report questionnaires measuring psychosocial (i.e., beliefs about medicines, perceived physician's communication effectiveness, medication-specific social support, self-efficacy) and behavioral factors (i.e., pharmacological adherence, medications refill adherence, intentional non-adherence) related to treatment adherence. Between-group comparisons and regression analyses were performed. RESULTS: Fisher's least significant difference (LSD) test showed significant differences between the Italian and Polish groups in all questionnaires (p < .01) with the Italian patients reporting more satisfactory scores. Younger age (ß = .08, p = .045), female gender (ß = 1.03, p = .042), higher medication refills adherence (ß = -.07, p = .024), lower intentional non-adherence (ß = -.03, p = .009), positive beliefs about medications (ß = .13, p < .001), better quality of communication with the physician (ß = .09, p < .001), and stronger perceived medication-specific social support (ß = .06, p = .001) were significantly associated with self-efficacy related to treatment adherence. CONCLUSIONS: Future research and interventions should leverage psychosocial and behavioral factors to address self-efficacy contributing to enhancing adherence to clinical prescriptions.

Sexual Dysfunction and Quality of Life in Patients with Rheumatoid Arthritis.

Background: Sexual health is a major component of human well-being. As repeatedly shown in research, satisfaction with sex life and sexual fulfillment correlate positively with quality of life (QoL) in most of its aspects. It is thus true that a reduced quality of one's sex life and lack of sexual fulfillment can contribute to poorer QoL overall. The aim of this study is to describe an assessment of sexual dysfunction and factors affecting sexual dysfunctions of patients with rheumatoid arthritis (RA). Material and methods: 171 consecutive RA patients (mean age 48.3 ± 14.6) attending the rheumatology outpatient clinic. Standardized questionnaires used in the study were the sexological questionnaire, WHOQOL-BREF to assess QoL level, Disease Acceptance Scale, and VAS scale to assess pain intensity. Results: The mean duration of the disease in the study group was 13 ± 9 years, mean score of subjective assessment of mobility was 6.2 ± 1.6, and the mean score of the DAS-28 was 4.0 ± 1.9. The study group presented a mean level of disease acceptance (AIS 29.6 ± 11.6). The comparative analysis showed significant differences in reaching orgasm and declared sexual dysfunctions. These problems occurred more often in women than in men (34.2% vs. 18% and 43% vs. 40%, respectively). In univariate analysis, factors correlating positively with the frequency of declaring sexual dysfunction were subjective motor score less < 6 points, AIS < 36 points, WHOQOL-BREF < 59 points, disease activity ≥3.5 points, and VAS > 3. In multivariate logistic regression analysis, independent factors positively correlating with frequency of sexual dysfunction declaration were general QoL (ß = 1.255; p = 0.035) and pain limiting social life (ß = 1.564; p = 0.030). The absence of comorbidities correlated negatively and reduced the prevalence of sexual dysfunction (ß = −1.030; p = 0.043). Patients with reduced QoL and patients with pain limiting social life had 3.5 and 4.8 times higher risk of sexual dysfunction than other patients, respectively. In contrast, those without comorbidities were 2.8 times more likely to be free of sexual dysfunction than those diagnosed with other chronic diseases besides RA. Conclusions: Sexual dysfunction is an emerging problem in both men and women with RA. The absence of comorbidities is an independent determinant of sexual dysfunction, whereas poor QoL and pain limiting social life are independent determinants that exacerbate sexual dysfunction in both genders.

Quality of Life and Depression in Rheumatoid Arthritis Patients Treated with Biologics - A Single Centre Experience.

Introduction: Patients with rheumatoid arthritis (RA) often experience depression, which has a very negative impact on the assessment of the quality of life (QoL). However, there are not many studies that assess the relationship between depression and QoL in RA patients. The aim of the study was to assess the level of QoL and determine the mutual relationship between anxiety and depression levels and QoL in patients treated for RA. Material and Methods: The study included 101 patients (aged:52.4±16.97), who met the established criteria for a diagnosis of RA and treatment with a biological agent. Only standardized tools were used to examine the patients: WHO-QoL, HADS and the VAS scale. Results: The mean RA duration in the group studied was 13.54±9.51 years and the disease activity score was 4.8±0.8. The mean QoL perception score was 3.48± 0.8. Nearly 40% of the respondents could not clearly determine their QoL, perceiving it as neither poor nor good, and 10% believed their QoL is poor or very poor. The correlation analysis revealed that anxiety is significantly and negatively associated with QoL in the psychological domain (r = -0.472, p < 0.001) and social domain (r = -0.298, p = 0.023) and depression is significantly and negatively associated with QoL in the psychological domain (r = -0.322, p = 0.01) and physical health domain (r = -0.209, p = 0.04). In the multiple linear regression model, depression was an independent negative predictor affecting the following domains: perception of QoL and perception of health, and physical health. Conclusion: RA patients treated with biologics present a low level of health perception and an average level of QoL perception. Depression and anxiety negatively correlate with QoL domains: the higher the anxiety and depression levels, the poorer the QoL in the psychological and social relationships domains. Depression is an independent determinant of decreased QoL.

Work Ability and Quality of Life in Patients with Rheumatoid Arthritis.

BACKGROUND: Reduced work participation has social implications (sickness absence, economic impact) and consequences for the individual patient (impoverishment, depression, limited social interaction). As patients with rheumatoid arthritis (RA) are more likely to experience job loss and/or at-work productivity loss and are at higher risk of sickness absence and, ultimately, permanent work productivity, consideration should be given to the association between work productivity or partial work capacity and quality of life (QoL). The aim of the study was to assess the relationship between QoL and the risk of work disability, as well as to estimate the risk of a future event and identify factors affecting the risk of work disability in RA inpatients. MATERIAL AND METHODS: This cross-sectional study included 142 inpatients (65 male) aged 47 (38-58) years, who met the established criteria for a diagnosis of RA and treatment with biologic drugs. Only standardized tools were used to examine the patients: WHOQOL-BREF, MFIS and AS-WIS. RESULTS: An analysis of the QoL scores on the WHOQOL-BREF demonstrated that the patients' QoL was lowest in the physical health domain and highest in the social relationships domain. The median WHOQOL-BREF total score in the group studied was 62.8, which indicates a moderate QoL. The median total score for the risk of work disability (AS-WIS) was 10.1, which indicates that the level of risk of work disability in the patients was higher than the average level reported in the literature. A multivariate analysis showed that the following were significant independent determinants of a higher risk of work disability: low QoL in the WHOQOL-BREF physical health (ß = 0.961; p = 0.029) and psychological health (ß = 1.752; p = 0.002) domains, being in a relationship (ß = 0.043; p = 0.005) and the use of opioids for pain (ß = 3.054; p = 0.012). CONCLUSIONS: RA patients presented with moderate QoL, moderate fatigue (MFIS) and high risk of disability (AS-WIS). There is an association between a high risk of work disability and lower QoL, especially in the physical and psychological health domains. The lower the QoL in those domains, the higher the risk of work disability. The identification of factors increasing the risk of work disability will help in planning tailored interventions to improve at-work productivity loss and thus prevent work disability.

The Relationship between Fatty Acids and the Development, Course and Treatment of Rheumatoid Arthritis.

For this systematic review, a search of the relevant literature was conducted in the EMBASE and PubMed databases. We used the following terms: 'rheumatoid arthritis' in conjunction with 'fatty acid'. The following inclusion criteria had to be satisfied for the studies to be included in the analysis: an RCT/observational/cohort study published in English. A total of seventy-one studies were analysed. The presented systematic review of the available data indicates that increased consumption of omega-3 fatty acids (FAs) may have a beneficial effect on human health by decreasing pain and disease activity in patients with RA. The beneficial effect of unsaturated FA on the clinical parameters of RA was demonstrated in all 71 studies analysed. The content of omega-3 FAs in the diet and the consumption of fish, which are their main source, may contribute to a reduced incidence of RA. FAs are an essential component in the synthesis of eicosanoids that exhibit anti-inflammatory properties. Due to the documented positive influence of unsaturated FAs on treatment outcomes, the use of a diet rich in long-chain unsaturated FAs should be the standard of care, along with pharmacotherapy, in the treatment of RA patients. An important element in the control of the treatment process should be the routine assessment of the quality of life of RA patients.

Responses of soccer players performing repeated maximal efforts in simulated conditions of the FIFA World Cup Qatar 2022: A holistic approach.

This study aimed to assess the capacity for repeated maximal effort (RME) of soccer players in the thermo-natural conditions (NC) and in simulated conditions for the 2022 FIFA World Cup in Qatar (QSC). Twenty-four semi-professional soccer players participated in the study. The exercise test consisted of ten 6-second maximal efforts on a cycloergometer. A 90-second passive rest interval was used. The test was performed in a Weiss Technik WK-26 climate test chamber in two different conditions: 1) thermo-neutral conditions (NC-20.5°C; 58.7% humidity); and 2) simulated conditions for the 2022 World Cup in Qatar (QSC-28.5 ± 1.92°C; 58.7 ± 8.64% humidity). Power-related, physiological, psychomotor, blood, and electrolyte variables were recorded. Results showed that (1) players achieved higher peak power (max 1607,46 ± 192,70 [W] - 3rd rep), needed less time to peak power (min 0,95 ± 0,27 [s] - 3rd rep), and had a higher fatigue slope (max 218,67 ± 59,64 [W/sek] - 7th rep) in QSC than in NC (in each repetition of study protocol); (2) between the 1st repetition and subsequent repetitions a number of significants in among physiological, blood-related, and electrolyte variables were noted, but their direction was similar in both simulated conditions (e.g. V'O2/kg 37,59 ± 3,96 vs 37,95 ± 3,17 [ml/min/kg] - 3rd rep, LAC 13,16 ± 2,61 vs 14,18 ± 3,13 [mg/dl] - 10th rep or K 4,54 ± 0,29 vs 4,79 ± 0,36 [mmol/l] - 2nd rep when compare QCS and NC respectively); (3) an 8°C of temperature difference between the climatic conditions did not significantly affect the soccer players' physical and physiological responses in RME. The study results can be used in the design of training programs aimed to increase players' physiological adaptations by simulating soccer-specific conditions of play in terms of anaerobic capacity, in particular, repetitive maximal efforts. These findings will be useful during the upcoming 2022 World Cup in Qatar and in locations where high ambient temperatures are customary.

The Role of Clinical Activity, Loneliness, and Satisfaction with e-Health Services as Factors Affecting Quality of Life in Patients with Rheumatoid Arthritis During the SARS-CoV-2 Pandemic.

INTRODUCTION: During the SARS-CoV-2 pandemic, most primary and specialist care outpatient clinics have started to offer their patients teleconsultation appointments as well as electronic prescriptions and referrals. For many patients, it was the only available way to access medical care. PURPOSE: The aim of the study was to assess the quality of life in rheumatoid arthritis (RA) patients and determine whether loneliness and satisfaction with telemedicine service can affect their perceived QoL during the SARS-CoV-2 pandemic. MATERIAL AND METHODS: One hundred and forty-three RA patients (mean age 45.83±13.5 years) were included in the study. The De Jong-Gierveld Loneliness Scale (DJGLS), The Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) and the questionnaire of satisfaction with teleconsultations were used in the study. The following statistical tests were used in the study: Spearman correlation test, multivariate linear regression. A significance level of 0.05 was used in the analysis. RESULTS: The patients presented a moderate level of loneliness (DJGLS; 31.1 points). The mean ASQoL score was 11.49±4.64. The correlation analysis showed a significant positive relationship between the level of loneliness and QoL - the higher the level of loneliness, the poorer the QoL (rho=0.283; p=0.001). An analysis of the relationship between satisfaction with teleconsultations and perceived QoL showed a statistically significant negative relationship - the higher the level of satisfaction with teleconsultations, the better the QoL (b=-0.166; p=0.047). The linear multivariate regression analysis showed that the loneliness (rho=0.1; p=0.01) was significant (p<0.05) independent predictor of QoL. CONCLUSION: During the SARS-CoV-2 pandemic, RA patients experienced loneliness and their QoL was low. Teleconsultation visits proved to be unsatisfactory and negatively perceived by patients. Higher severity of RA symptoms (weakness, fatigue), being unemployed and loneliness during the blockade are independent determinants of reduced QoL in RA patients.

Association between Malnutrition and Quality of Life in Elderly Patients with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a progressive articular disease. In addition to damaging the joints, it may cause multiple organ complications, and considerably impair the patient's functioning. Elderly patients with RA report pain, fatigue, mood disorders, sleep disorders and insomnia, accompanied by weakness, poor appetite, and weight loss. All these factors combined have an adverse effect on the patient's perceived quality of life (QoL). Due to the chronic nature of RA and the high risk of malnutrition in this patient group, the present study investigated QoL, activities of daily living, and frailty syndrome severity in relation to MNA (Mini Nutritional Assessment) questionnaire scores among elderly RA patients. The study included 98 patients (aged over 60) diagnosed with RA per the ARA (American Rheumatism Association) criteria. The following standardized instruments were used: WHOQoL-BREF for QoL, the Edmonton Frail Scale for frailty syndrome severity, MNA for nutritional status assessment, and MMSE (Mini-Mental State Examination) to assess any cognitive impairment. Medical data were obtained from hospital records. Patients with a different nutritional status differed significantly in terms of limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). Higher levels of malnutrition were associated with greater limitations in activity. An adverse impact of lower body weight on cognitive function was also observed (dementia was identified in 33.33% of malnourished patients vs. 1.79% in patients with a normal body weight). Likewise, frailty was more common in malnourished patients (mild frailty syndrome in 33.3%, moderate in 16.67%, and severe in 16.67%). Malnourished patients had significantly lower QoL scores in all WHOQoL-BREF questionnaire domains than those with a normal body weight, and multiple-factor analysis for the impact of selected variables on QoL in each domain demonstrated that frailty was a significant independent determinant of poorer QoL in all domains: perceived quality of life (ß = -0.069), perceived health (ß = -0.172), physical domain (ß = -0.425), psychological domain (ß = -0.432), social domain (ß = -0.415), environmental domain (ß = -0.317). Malnutrition was a significant independent determinant of QoL in the "perceived health" domain (ß = -0.08). In addition, regression analysis demonstrated the positive impact of male sex on QoL scores in the psychological (ß = 1.414) and environmental domains (ß = 1.123). Malnourished patients have a lower QoL than those with a normal body weight. Malnutrition adversely affects daily functioning, cognitive function, and the severity of frailty syndrome. Frailty syndrome is a significant independent determinant of poorer QoL in all WHOQoL BREF domains.

Impact of Cognitive Impairment on Adherence to Treatment and Self-Care in Patients with Type 2 Diabetes Mellitus.

BACKGROUND: Elderly patients with diabetes have a significantly increased prevalence of mild cognitive impairment compared with people of similar age without diabetes. Tasks related to diabetes self-management involve multiple cognitive skills and processes, such as memory, attention, planning, and calculating. Impaired cognitive function can threaten the patient's ability to perform self-monitoring. The objectives of the study were: to assess cognitive deficits and the level of self-care in elderly patients with diabetes, to identify correlations between cognitive deficits and self-care, and to determine which variables influence self-care behaviors and cognitive deficits. METHODS: The study involved 169 patients with type 2 DM. Standardized tools were used: Mini-mental State Examination (MMSE) to assess cognitive function and the Self-Care of Diabetes Inventory (SCODI) to assess the level of self-care. Socioclinical data were taken from the hospital records. RESULTS: 56.8% of patients had cognitive impairment (MMSE≤26). In the comparative analysis, patients with cognitive impairment had significantly lower results in all domains of the SCODI: self-care maintenance (72.9 vs 75), self-care monitoring (53.1 vs 56.3), self-care management (71.9 vs 84.4), self-care confidence (79.5 vs 86.4). Correlation analysis showed that the MMSE score correlates significantly and positively (p˂0.05; r˃0) with all SCODI subscales, and the higher the MMSE score the higher the level of self-care (A: r=0.252, B: r=0.244, C: r=0.019, D: r=0.28). CONCLUSION: In this elderly type 2 diabetes population, and using only one test to verify the cognitive function, self-care management was worse in terms of self-care management (blood glucose control). Cognitive function components are independent determinants of self-care in patients with type 2 diabetes. Recall is an independent predictor of self-care maintenance, and writing a predictor of self-care monitoring.